1. Teaching PCMH Concepts A Plan Do Study (Act) Adventure
Please note that more information about our project and the practice registry can easily be downloaded from our website
Kelly Bossenbroek Fedoriw MD
Beat Steiner MD MPH
University of North Carolina SOM
Chapel Hill

2. Goals of Session
Get you excited about teaching PCMH
Give you specific tools to use
Report initial results from our curriculum
Get input from you on how to improve

3. CARE Assignment
Integrate sometimes conflicting guidelines into the lives of patients with multiple chronic illnesses.
See individual patients as part of a larger population that can be cared for with system level interventions.

4. CARE assignment
Learn about MI and goal setting (TBL)
Work closely with one patient
Review relevant guidelines
Make recommendations
Introduction to registries (TBL)
Study population of patients

5. Individual Readiness Assessment Test (iRAT)
Team Based Learning
Individual Readiness Assessment Test (iRAT)
Group Readiness Assessment Test (gRAT)
Application Questions
1st TBL session during orientation that focuses on motivational interviewing and the social determinants of health
2nd TBL session – PCMH concepts and moving from the idea of treating an individual patient to the population. This includes an overview of registries.

6. Teaching Registry
A disease based registry is essential for teaching the concepts of PCMH but practice registries are not readily available. About one year ago we developed a curriculum using team based learning and a practice registry to teach these concepts.

7. Access the Registry Google: url:
UNC family medicine clerkship teaching registry
url:

8. Access
Via

9. 10 minutes to work on questions #1 and #2
Registry
10 minutes to work on questions #1 and #2
Then 10 min debrief – Benefit of TBL format is the discussion and active learning
Was there discussion?
Did they feel like the answers were accessible within the registry?
Students tend to understand the workings of the registry much more quickly than faculty.
Preceptors office’s may not have a registry and that’s ok. Students are still exposed and are beginning to understand the benefits of a registry and it’s limitations.
Ask for show of hands for answers
A group of high risk patients have been embedded in the registry. About 25 patients have very high blood pressures and also high HgbA1c values. This group has a disproportionate % of co-existing mental health conditions and do not show up as regularly for routine care. This group is also concentrated in census tract 201. Steiner sees more patients in that census tract. Students may hypothesize that Steiner is providing substandard care but the more likely explanation based on the information in the registry is that social determinants in census tract 201 are responsible for pattern.

10. Learn about MI and goal setting (TBL) Work closely with one patient
CARE assignment
Learn about MI and goal setting (TBL)
Work closely with one patient
Review relevant guidelines
Make recommendations
Introduction to registries (TBL)
Study population of patients
Going back to the CARE assignment. Now that the students have had exposure to PCMH concepts and registries, we ask the students to identify 8-10 patients with similar characteristics to their individual patient and do a chart review. The final product of the assignment is a detailed document with reflective writing as well as specific recommendations for the care of their individual patient as well as the population of patients they studied. This goes back to the preceptor – examples in the handout.

11. Preceptor Survey
36% of preceptors felt that students offered useful suggestions for the care of a population
Change in Practice?
Pool therapy suggestion for pt with OA
Looking for polypharmacy
Monitor medication compliance more carefully
Referral for home health services
I would love to see more specific recommendations elicited by the students.

12. 48/63 students responded = 76% response rate
Student Survey
48/63 students responded = 76% response rate
75% of students spent 5-15 hours on assignment
76% of students felt the assignment was effective or very effective (worth the time invested)
Time spent – 75% spent 5-15 hours, 20% spent over 15 hours
76% response rate – 48 students

13. Most important lesson learned?
Individual
Population
Community Resources
Impact of comorbidities
Benefits of registries
Individualize guidelines
Systems Based Change
Social Determinants
PDSA cycles
Motivational Interviewing

14. “I began to think like a responsible health care provider and member of society. My goal is not just to improve the health of an individual but the health of the community.”

15. Discussion Questions
Would assignment generalize to your setting?
Is assignment appropriate for 3rd year students?
How could the practice registry be improved?